What is the optimal sequential therapy after secondary IL-17A inhibitor failure in psoriasis: switching to an IL-23 inhibitor or to another IL-17A inhibitor?

BACKGROUND

An increasing number of psoriatic patients are experiencing secondary failure with interleukin (IL)-17A inhibitors, highlighting the urgency to identify effective switching strategies. We evaluated the effectiveness and treatment patterns of intraclass versus interclass switching therapies in psoriasis patients experiencing secondary failure to IL-17A inhibitors over a 28-week period.

METHODS

This single-center, retrospective analysis included psoriatic patients who experienced secondary failure to either ixekizumab or secukinumab and subsequently switched to another IL-17A inhibitor (ixekizumab or secukinumab; intraclass switching group) or to an IL-23 inhibitor (guselkumab; interclass switching group).

RESULTS

80 patients were enrolled, including 47 in the intraclass switching group and 33 in the interclass switching group. The mean psoriasis area and severity index and dermatology life quality index were lower in the intraclass switching group compared to the interclass switching group at each time point over 28 weeks (p < .05). The discontinuation rate was higher in the interclass switching group (24.1%) compared to the intraclass switching group (2.7%; p < .05). Previous exposure to ≥2 biologics working on different pathways was identified as a risk factor for treatment failure in the interclass switching group.

CONCLUSION

An intraclass switch following IL-17A inhibitors failure yielded better treatment outcomes than a switch to guselkumab.